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Gray, Julie Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records,. Name First Middle Last Sex Julie Ann Gray Female Date of Death Age If Veteran of U.S.Armed Forces, 10/07/2023 65 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 7 Hughes Court,Queensbury Town,New York 12804 p Manner of Death ❑X Natural Cause IllAccident Homicide El Suicide Undetermined Pending W Circumstances Investigation 0 Medical Certifier Name Title Robert Reeves MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 157 Burial Date Cemetery,Crematory or Facility Name 10/10/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation 0❑Removal Date Place Removed and/or and/or Held - Hold Address 0 Q. Date Point of Cl) Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address EIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 2 Address CC Cl. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/10/2023 Registrar of Vital Statistics Caroline NIfiegardf Bar6er(Electronically Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 10►II(l3 Place of Disposition -Frei EJI 2 (address) W CC (section) / (/ot number) (grave number) gName of Sexton or Person in Charge of P ises 6/ r"`� �►i W (pile print) l hl- el Signature Title •fir DOH-1555(07/18)p 1 of 2 I Public Health Law Sec. 4145(2b) Receipt 1 Human remains of -- delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#_